T

he cure rate for children with the most common pediatric cancer, acute lymphoblastic leukemia (ALL), is 90 percent. What endangers the remaining 10 percent? Poverty may be one culprit.

In a decade-long study of 757 ALL patients published in Pediatric Blood & Cancer, children from high-poverty areas faced early relapse more frequently than wealthier peers. STAT spoke with study co-author Dr. Kira Bona of the Dana-Farber Cancer Institute.

How does this add to existing research?

Two other studies have shown that poor children with ALL have lower overall survival rates, but no one has been able to look at potential causes for that. We found that children who came from high-poverty areas were significantly more likely to experience early relapse than those from low-poverty areas, and if a child relapses earlier, it’s harder for us to salvage them.

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Can you hypothesize about why these children might be relapsing earlier?

We don’t know. It’s possible it has something to do with chemotherapy delivery. It’s given inpatient initially, and then for two years it’s given orally at home. It’s certainly possible there could be differences in adherence rates between children in high- and low-poverty areas, and that could affect your timing to relapse.

Less affluent children tend to be less healthy to begin with, right?

They have worse underlying health, so they may be more at risk for toxicities from chemo, which could lead us to delaying or dose-reducing their chemotherapy. There are a number of possibilities, some of which we’ll look at in our next trials.

 

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